伤寒Typoid Fever

period
Regional lymphatics
Blood stream - first bacteremia
initial MPS in liver, spleen, bone marrow
Blood stream -second bacteremia
endotoxin liver spleen regional lymphotics
Clinical manifestation
Incubation period: 7-23 day(average 10 to 14 days)
Typical typhoid fever: ➢ Initial period ➢ Fastigium ➢ Defervescence ➢ Convalescence
Clinical symptoms absces
inflammation
Pathology
Proliferation of large mononuclear cell
1st week proliferation
edema
2nd 3rd week necrosis ulceration
4th week heal no scar
Devervescence Convalescence
Clinical manifestation
❖Clinical type:
➢Mild type ➢common type ➢prolonged type, ➢ambulatory type ➢fulminate type
Clinical manifestation
➢ isolation
❖Interruption of route of transmission ❖Protection of susceptible population :
Vaccinated with vaccine
Paratyphoid
❖Paratyphoid A & B are the same as typhoid fever
Relapse: It occur 1~3week after T has reached
normal. The illness follows a similar pattern to the primary attach. Blood culture positive.
Recurrence: It occur 3~4 after the illness. T
heat, acid, common disinfectants
Etiology
❖Antigenicity:
➢O antigen: lipopolysaccharide group-special
➢H antigen: protein, strain-special ➢Vi antigen: polysaccharide
❖Paratyphoid C: septics or gastro-interitis
begin to fall, then rise again. Blood culture positive.
Complications
❖Intestinal hemorrhage ❖Intestinal perforation ❖Toxic hepatitis and myocarditis ❖Pneumonia
Clinical ຫໍສະໝຸດ Baiduanifestation
Fastigium
➢rose-colored rash:
erythematous macules or papules occur on 6~13 days upper abdomen
➢hepatomegaly and splenomegaly
Clinical manifestation
Treatment
❖General therapy ❖Etiologic therapy
➢ guinolone: first choice ➢ cephalosporins: 2nd and 3rd generation ➢ chloromycetin
Prevention
❖Control of source of infection:
➢sustained fever ➢toxic symptoms:
NS apathy, tinnitus, delirium,lethargy, coma DS anorexia, abdominal Pain, diarrhea Constipation CS relative slow pulse, bradycardia, myocarditis
Diagnosis
❖Epidemiological data ❖Clinical manifestation ❖Laboratory findings ❖Definitive diagnosis:
positive
bacteria
culture
Differential Diagnosis
❖Typhus ❖rickettsises ❖malaria ❖disseminated TB
❖Complication hemorrhage & perforation
Etiology
❖Causative organism: Typhoid bacillus
genus salmonella group D
❖Pathogenicity: endotoxin ❖Resistance: Stable in environment, sensitive to
Laboratory Findings
❖Blood picture: leukopenia ❖Bacteria culture:
➢ blood ➢ bone morrow ➢ urine and stool
Laboratory Findings
❖Widal test: agglutination of serum reaction 5 Ag: “O” “H”, “HABC” titer:O>=1:80 H>=1:160 results analysis:
Epidemiology
❖Source of infection
Patient, Carrier, shed bacteria in feces
❖Route of transmission Fecal-oral route:
➢contaminated food or water ➢contagious spread ➢ spread by insect
❖Place of lesson lymphatics in the terminal ileum ❖Pathological feature proliferation of large
mononuclear cells derived from MPS
Definition
❖Clinical feature sustained fever relative slow pulse toxic symptoms a rose-color rash splenomegaly and hepatomegaly leukopenia
Typhoid Fever
Dept. Infectious Disease 2nd Affiliated Hospital
CMU
Definition
❖Typhoid fever is an acute infectious disease of digestive tract caused by typhoid bacillus.
❖Susceptibility ❖Epidemic features sporadic cases
high incidence in fall & summer
Pathogenesis
Bacillus Stomach killed by gastric acid
incubation Small intestine penetrate mucosa
Clinical manifestation
Initial period
➢onset: insidious, gradual ➢fever: T stepwise fashion rising ➢non-special symptoms:
Clinical manifestation
Fastigium